Provider Demographics
NPI:1710994918
Name:MUSSELMAN, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:MUSSELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 SAHARA TRAIL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3667
Mailing Address - Country:US
Mailing Address - Phone:330-758-9787
Mailing Address - Fax:330-758-9792
Practice Address - Street 1:904 SAHARA TRAIL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-758-9787
Practice Address - Fax:330-758-9792
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052402208800000X
PAMD061679L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000137271OtherANTHEM
OH1900148OtherUNITED HEALTH CARE
GA340011711OtherPALMETTO GBA RAILROAD MED
OH83077OtherQUALCHOICE
OH0666515Medicaid
OH1900530OtherUNITED HEALTH CARE
OH1900407OtherUNITED HEALTH CARE
PAMU442601OtherHIGHMARK
OHMU0599072Medicare PIN
OH1900148OtherUNITED HEALTH CARE
A16921Medicare UPIN
OH0666515Medicaid